Journal of Nervous and Mental Disease (Volume 26 ) (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1899. Excerpt: ... ON SENSORIMOTOR PALSIES OF THE MUSCULATURE OF THE FACE, WITH REMARKS ON THE OCULAR PALSIES OF THE EARLY STAGES OF TABES.' By Joseph Fraenkel. M.D., Physician in charge of the Montefiore Home; Instructor in Nervous Diseases at the Cornell University Medical School; Neurologist to the City Hospital. About one year ago 1 reported to this society a case of disease of the base of the brain with implication of the fifth nerve, and remarked on that occasion, when speaking about the motility of the face, the following: "The examiner's attention is first arrested by the patient's facial expression. The left side of the face seems contractured; the left-sided temporal and masseter muscles appear atrophied. The left eyelid is drooping. The degree of contraction of the muscles of the left side of the face and the width of the left palpebral fissure are by no means constant; they vary greatly from day to day, and even during one examination. These variations are greater than would correspond to mere physiological changes of the physiognomy, and are confined to the diseased side. For instance, the lid that was drooping at one time is unduly elevated at another time, exposing a part of the upper margin of the sclera. At first it appears as if the right-sided facial nerve were paralyzed, because the folds around the eye and angle of mouth of the left side are much deeper. However, when the patient is put through the usual tests to determine the state of the facial zierve, the right facial nerve is found to be absolutely normal, while in the distribution of the left a phenomenon is noticed, that can best be compared to the ataxia and over-innervation commonly observed in the extremities of tabetic patients. The patient performs all motor functions with the left facial ner...